In 1996, it took all of Boston Mayor Thomas Menino’s political muscle to pull off what some consider a managerial miracle. Despite intense union opposition, a reluctant city council and concerns about health care costs, Menino fought successfully for the merger of two city hospitals that had been founded in the mid-19th century. Continue reading
Listening to Patients
By Richard Knox
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.
For those who believe universal coverage is a good thing, prospects aren’t good, judging from an analysis of 27 national polls scoured by researchers at the Harvard School of Public Health.
Taken altogether, the polls show increasingly negative views of the four-year-old Affordable Care Act among likely Republican and independent voters. That could tip control of the U.S. Senate to the Republicans, enabling them to attack the ACA through the budgetary process — crippling it even if they can’t repeal it without President Obama’s signature.
Six states with too-close-to-call U.S. Senate races are unfriendly territory for the Affordable Care Act, the 2010 law that aims to insure nearly all Americans.
In contrast to Massachusetts — where 57 percent support the ACA — fewer than half the voters like the health care law in New Hampshire, Colorado, North Carolina, Louisiana, Kentucky and Arkansas.
“These are states where President Obama is very unpopular,” says study author Robert Blendon. “And Obamacare is not popular in those states.”
The problem, for the president and ACA supporters, is greatly worsened by low turnout. Fewer than 6 in 10 voters are expected to cast ballots, and the polls show likely voters are less inclined to support the ACA than the public at large.
“In a low-turnout election, the voters are disproportionately the core of either party,” Blendon says. “And views on what should happen with the ACA are very polarized” between the two major parties.
Ten years ago, with little warning, Liss Murphy fell victim to paralyzing depression, a “complete shutdown.”
She was 31, living in Chicago and working in public relations. The morning of Aug. 13, 2004, she had gone in to the office as usual. “It was Tuesday, and I remember the day so clearly,” she says. “The sun — everything — and I walked out — it was about 11 o’clock — and I never went back. The only time I left the house was to see my psychiatrist, who I saw three times a week.
“I have a hard time believing it was depression, in a way, because it was so pervasive and powerful,” she says. “It invaded every aspect of my life. It took so much away from me. And it happened so fast, and it was so degrading — it took everything from me.”
Murphy came home to Boston, and she tried everything — medications, talk therapy, even repeated rounds of electroshock. But she was barely able to get out of bed for months — then years. Her husband and family and top-flight doctors cared for her, but she sank so low she tried twice to commit suicide.
Finally, a psychiatrist told her about a cutting-edge trial to implant stimulation devices deep in the brains of patients with severe depression. She signed up. In June of 2006, she had the operation.
“My greatest hope that day was to have something go horribly wrong and die on the table,” she says. “I didn’t care.”
She didn’t die. Over the next few months, she got better. These days, eight years after the surgery, if you saw Liss Murphy walking her Old English Sheepdog, Ned, or playing with her 3-year-old son, Owen, only the faint silver scars on her clavicles would hint at anything unusual: That’s where the batteries that power her brain stimulator are implanted.
But though the surgery changed Murphy’s life, “the trial, on average, didn’t work,” says Dr. Emad Eskandar, the Massachusetts General Hospital neurosurgeon who operated on her. “When you pooled everyone together it didn’t work. But there were like five people out of the 10 we did that had remarkable benefits and went into complete remission. We couldn’t continue with the study because on the average it failed, but for those people in whom it worked, boy did it work.”
Now, as part of a $70-million project funded by the military, researchers are aiming to take brain implants for psychiatric disorders to the next level.
Over the next five years, they aim to build a device that can sit inside a patient’s head, pick up the onset of depression or post-traumatic stress disorder, and head it off before it hits. One implant researcher calls it “a moonshot for the mind.” Continue reading
Liss Murphy of Boston was one of the first people in the world to be successfully treated for severe depression with Deep Brain Stimulation, an electrical device implanted deep inside her brain. Now, researchers funded by the Department of Defense are trying to bring that technology to the next level, and use it to treat depression and PTSD. Here, she describes her own experience before and after the operation that changed — perhaps saved — her life.
By Liss Murphy
What is depression? After all this time, I should know. I don’t.
I know some things about depression, though. Depression is the ultimate subtractor, a thief. It erodes just about everything you are, you were, you have, you want. It takes the promise out of your existence. It destroys any semblance of hope or potential or desire or goodwill. Gone, it just is gone. It is utterly corrosive in a way that I still cannot understand.
Depression stripped my life of many things, of everything I knew at the time. It took away the promise of a normal day; the ability to enjoy and progress in my career and interests and relationships; the ability to think.
What follows is an attempt to make sense of the unknowns, of which there are many. But also, what follows is a story of sickness, recovery, healing and acceptance.
What was it about August 13, 2004 that made the day what it was?
I have been told that I’d had depression before. Sure, I’d felt lousy, hopeless, tormented. But I was able to function. I could and did go on, as I needed to. It was not a roadblock.
This 2004 episode was different in every possible way. It descended on me overnight, it seems. Yes, I had been tearful and unhappy for a few weeks leading up to my crash, upset that my husband and I had separated. But so what?
The details are foggy, though some of it seems so clear and vivid. It was a Tuesday, a gorgeous sunny August day. My office had a view of Lake Michigan. I walked out of the office mid-morning and never returned. My computer was on, my running clothes, sneakers, other personal belongings in my office – waiting for me to return. But I never went back.
One important detail I cannot recall is whether I drove to work or took the subway. I think I drove but … I am hung up on those details now. Because that day I did not just have a mental meltdown; it was the beginning of a complete system meltdown — a mental, physical, psychological, physiological meltdown. A total shutdown.
I can still see each room in my Chicago apartment as it was back then, as confused as I was. Each day, the rooms got more confusing, more messy, until it all blended into a universal squalor. I see images of brown rice boxes on the kitchen counter, dull steak knives, the tips of burning cigarettes against the hue of a bluish-purple sky just before nightfall. I slept on the couch. I stopped running, started smoking. After that day in August, I only left to see my psychiatrist, three or four times a week, until I came home to Boston.
It wasn’t feeling sad. It was feeling nothing. It was a total void of feeling. For two years, I was basically mute — totally withdrawn from everything. Continue reading
Remember the neuroscience study this spring that seemed to indicate that even casual marijuana use could cause lasting changes in teen brains? It was, shall we say, a bit controversial — to the point that the Knight Science Journalism Tracker, a leading arbiter of science coverage, questioned both what the study’s authors said and how the media handled it, here: Don’t bogart that joint: Casual marijuana use linked to brain changes?
Now, a new study on rats out of the University of Massachusetts at Amherst and Louisiana State suggests that binge drinking in adolescence can cause long-lasting damage to brain pathways still developing in the young. The press release quotes neuroscience researcher Heather Richardson of UMass:
“Adverse effects of this physical damage can persist long after adolescent drinking ends. We found that the effects of alcohol are enduring.” She adds, “The brains of adolescent rats appear to be sensitive to episodic alcohol exposure. These early experiences with alcohol can physically alter brain structure, which may ultimately lead to impairments in brain function in adulthood.”
She and her colleagues believe their study is the first to show that voluntary alcohol drinking has these effects on the physical development of neural pathways in the prefrontal cortex, one of the last brain regions to mature.
In humans, early onset of alcohol use in young teenagers has been linked to memory problems, impulsivity and an increased risk of alcoholism in adulthood. Because adolescence is a period when the prefrontal cortex matures, Richardson adds, it is possible that alcohol exposure might alter the course of brain development. Rodent models used in this study are documented to have clinical relevance to alcohol use disorder in humans.
Of particular concern: I think of the prefrontal cortex as, well, where I think, the seat of rationality and control, the highest of the higher brain functions. Not a good place to damage — not that there’s any good place in the brain to damage.
On the lasting effects: Continue reading
We can all pretty much agree that air travel, even in the best of circumstances, isn’t fun. But for nursing mothers who must get on a plane for work, air travel can be particularly harrowing.
Now, a survey finds that despite new state and federal workplace laws that require certain employers to provide moms who breastfeed or pump with a lactation room (that means a private space — not a bathroom — with a chair, table and electrical outlet) airports are doing a pretty lame job on this front.
The study, a phone survey of customer service representatives at 100 U.S. airports (that in itself sounds harrowing) found that while 37 percent of respondents reported having a designated “lactation” room, 25 percent of those considered unisex or family bathrooms to fit the bill. The report, published in the journal Breastfeeding Medicine, concludes:
Only 8% of the airports surveyed provided the minimum requirements for a lactation room.
However 62% stated they were breastfeeding friendly. Airports need to be educated as to the minimum requirements for a lactation room.
Caveat: One of the study authors co-owns the breast pump company Limerick, Inc. Still, the findings should be of interest to any mom grossed out by the prospect of pumping in the internationally-germ-laden (just a guess) “family restroom” at LaGuardia. Continue reading
By Richard Knox
The United States has entered a new phase in its response to Ebola. Call it “officially sanctioned panic.”
Governors from both parties — N.J. Gov. Chris Christie and N.Y. Gov. Andrew Cuomo — declared over the weekend that even symptom-free health care volunteers coming home from Ebola duty in West Africa will be considered infected (and infectious) until they prove otherwise — by not falling ill for three weeks after their return.
But experts say mandatory quarantine of health workers and travel bans are unnecessary and could cripple the global fight against Ebola.
Against this backdrop, I had a long conversation this past weekend with Prof. Alessandro Vespignani. He’s a Northeastern University expert on how humans behave in the face of disease threats. The main takeaways: The key to defeating the outbreak is to get health care workers to West Africa and back, so to the extent a travel ban or quarantines impede that flow, they will be dangerously counter-productive. And travel is so hard to control fully that bans do little to stem the spread of disease anyway.
Vespignani is spending a lot of time these days consulting with the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and the World Health Organization on how the Ebola situation could evolve over the coming months.
He’s thinking some ominous thoughts, which he says reflect the views of U.S. and international health officials that he talks to. But the scenarios they worry about are very different from those that preoccupy many politicians and voters. Politicians worry more about the small, containable immediate threat to Americans of occasional imported cases than the longer-term and potentially catastrophic Ebola scenario that could affect the whole world — in other words, an Ebola pandemic.
Here’s an edited version of our conversation:
RK: Your group published a paper the other day in the journal Eurosurveillance that would seem counter-intuitive to many Americans. You say that imposing a ban on travelers from Ebola-affected countries won’t do much to prevent importation of the virus to the United States. Why is that?
Vespignani: People think if you have a travel ban everybody from those countries will be kept out. It’s not like that.
It’s important to know that we don’t have direct flights from West Africa. So a travel ban has to be coordinated internationally. There are a lot of people with two passports (whose country of origin can’t be easily tracked). People would try to circumvent the travel ban, and they wouldn’t be trackable — that’s one of the most dangerous things.
You can stop 95 percent of travelers from a country, but it’s very difficult to do 100 percent. And even a 90 or 95 percent travel ban is going to delay the arrival of Ebola (in the U.S.) by only about two months. It’s only buying time.
Already there is almost an 80 percent reduction in travel to the U.S. from that region, so we have already bought some time — about four to five weeks.
So what’s the practical effect of that delay? How much would a travel ban reduce Americans’ risk? Continue reading
It’s nearly half the state budget, almost 20 percent of the state’s economy and a perennial top concern for voters. The issue is health care, and so far, neither Democrat Martha Coakley nor Republican Charlie Baker has taken the lead on this topic with voters in the gubernatorial race.
“Coakley has perhaps a slight edge on the general health care issue, as well as the affordability issue, but neither campaign has really broken away” on health care, said Steve Koczela, president of the MassINC Polling Group. “It’s not like taxes, which go big for Baker. It’s not like education, which tends to go a bit bigger Coakley. It’s an issue that is still very closely fought.”
So where do the gubernatorial candidates stand on some of the key concerns in health care? Below is a summary of the candidates’ proposals for how to treat the health of the state.
On Making Health Care More Affordable:
BAKER: He argues that giving patients information about how much tests and procedures cost, in advance, will help us become informed consumers of care. We’ll spend less money, because we’ll choose to have a baby, for example, at the hospital with the lowest cost and best quality scores. As of Oct. 1, health plans in Massachusetts are required to post what they pay each hospital and doctor.
Baker would take a next step. “I’d like to get to the point where hospitals just post prices and people can see them plain as day,” Baker said. “As governor, I’m going to lean really hard on this.”
Some health care analysts say Baker’s strategy for reducing health care costs could backfire. Patients may assume that the most expensive hospital is the best even though that’s generally not true. And letting Brockton Hospital, for example, know that it is paid about half of what Massachusetts General Hospital receives for a C-section may mean Brockton Hospital demands more money, instead of MGH saying, “OK, I’m going to lower my prices to compete.” In addition, some of the expensive hospitals say their higher prices subsidize teaching and research.
COAKLEY: She argues she is uniquely positioned to tackle health care spending. She created a health care division in the attorney general’s office, issued the first detailed reports on health care costs and used her leverage to negotiate a deal that would limit the price increases Partners HealthCare could demand in the near future.
“The agreement that we have reached, to be approved by the court, caps costs and lowers costs as opposed to maintaining the status quo, which we all agree is too expensive,” Coakley said during a campaign debate on WBZ-TV. Continue reading
Massachusetts has no plans to follow New York and New Jersey in requiring a three-week quarantine for health care workers and others who have had contact with Ebola-stricken patients.
“It’s probably a step further than we need here in the Commonwealth,” Gov. Deval Patrick said in comments provided by his press office, “but we’re prepared. It’s certainly a step further than what the CDC has recommended.”
Patrick said his counterparts, Andrew Cuomo in New York and Chris Christie in New Jersey, may have more reason to be concerned about Ebola.
“I understand why they are going to the extent they are going to, because two of the five receiving airports are in New York and New Jersey,” Patrick said.
Illinois Gov. Pat Quinn joined Cuomo and Christie Friday in imposing a quarantine on travelers who could be infected with Ebola.
A nurse placed under quarantine in New Jersey Friday described a chaotic scene at Newark Airport.
In Massachusetts, Patrick and Boston Mayor Marty Walsh have focused on calming public fear about Ebola.
“I understand that folks are anxious,” Patrick said again on Saturday. “We have worked very hard to make sure that our medical professionals have all of the guidance that we have, and that training is happening where and as it should, that public safety officials are fully briefed and prepared. From all accounts from the professionals, the risk is very, very low in Massachusetts.”
That assessment is based on the expectation that there is not much travel between Boston and West Africa right now, that Ebola does not easily spread, and that hospitals are prepared to handle any cases that may arise.
“It is obviously dangerous,” Patrick said, but “you have to be directly exposed to the bodily fluids of someone who is showing symptoms of Ebola, not someone who has been near somebody with Ebola. If people are showing any of those symptoms — nausea, high fever — they should get themselves to an emergency room quickly, and there are protocols for testing.”
The CEO at Partners HealthCare, the state’s largest private employer, plans to step down.
Dr. Gary Gottlieb agreed Friday to become the CEO at Partners in Health, a global health organization whose latest project is an Ebola response effort in West Africa.
Gottlieb is scheduled to make the transition on July 1, 2015. His decision comes amid acourt review of Partners’ controversial expansion plans and questions about Gottlieb’s ability to manage political dynamics outside the hospital network.
His supporters point out that Gottlieb has just begun his second five-year contract, and they say Partners board members urged Gottlieb to stay. But some current and former Partners leaders say dissatisfaction with Gottlieb’s leadership has been building for months and that the Partners in Health job offers Gottlieb a graceful way out.
He will take a dramatic pay cut, from more than $2 million a year to $200,000 a year at Partners in Health.
Gottlieb serves on the board at Partners in Health, has visited the group’s projects in Haiti and Rwanda, and calls it the most important global health initiative in the world.
“This is a singular opportunity to lead that organization at a time when it is clear that improving sustainable health care throughout the world is critical to all of us,” Gottlieb said.
Gottlieb says he began thinking seriously about moving to Partners in Health this summer, and decided to make the change earlier in the fall after hearing Partners in Health co-founder Paul Farmer describe what was happening in West Africa.
“With Ebola, maternal deaths had increased because there was no place for people to deliver babies,” said Gottlieb. “Malaria deaths had increased because there was no way to provide the appropriate care for what is a more ordinary terrible disease. The notion that building sustainable health care was essential for real social justice and real change had become even more obvious.” Continue reading